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4PY019

Pharmacy, pharmacists & the NHS

Pharmacy, pharmacists & the NHS

Facilitator

Further reading

David Gay

This study pack

Contact Details

Chapters 5 & 14 in Pharmaceutical Practice. Rees, Smith and Watson. 5th Edition.

[email protected]

Learning Outcomes

This pack explores the profession of pharmacy and charts recent changes in roles and responsibilities, and places pharmacy in the broader context of healthcare delivery within the NHS. On completion of this pack you should:      

be able to explain the origins of pharmacy; understand how the profession of pharmacy developed; know how pharmacy is regulated; describe core functions of the pharmacy team; be able to describe the current NHS structures; be aware of working in multidisciplinary healthcare teams;

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Contents Introduction...................................................................................................................................... 4 Chemist, chemist and druggist, pharmacist or apothecary?.............................................................4 Becoming a pharmacist.................................................................................................................... 5 The Pharmacy Team........................................................................................................................ 6 Where do Pharmacists work?.......................................................................................................... 6 What does a pharmacist do?............................................................................................................7 The Royal Pharmaceutical Society................................................................................................. 10 The General Pharmaceutical Council............................................................................................. 10 The Structure of the GPhC.............................................................................................................11 GPhC Committees..........................................................................................................................11 Standards....................................................................................................................................... 12 Fitness to practise....................................................................................................................... 13 What does fitness to practise mean?.......................................................................................... 13 The General Pharmaceutical Council and fitness to practise......................................................13 The School of Pharmacy............................................................................................................ 13 Why is fitness to practise important?..........................................................................................14 GPhC standards for pharmacy professionals.............................................................................15 Fitness to Practise impairment.................................................................................................... 16 Common fitness to practise problems.........................................................................................16 NB. Police cautions..................................................................................................................... 17 Health problems including mental illness....................................................................................18 Drug or alcohol misuse...............................................................................................................18 Academic misconduct................................................................................................................. 18 Social media............................................................................................................................... 18 Fitness to Practise Procedure.....................................................................................................20 Continuing professional development............................................................................................ 21 The NHS and Pharmacy’s Place.........................................................................................................22 The Structure of the NHS............................................................................................................... 22 Multidisciplinary Teamworking........................................................................................................ 27 Characteristics of an effective team?..............................................................................................28 Barriers to Effective Team working?...............................................................................................29

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Introduction This is your first study pack in the ‘Pharmacists, patients and medicines’ strand of year one of the University of Wolverhampton MPharm course. This pack is designed to provide context to the profession of pharmacy. The pharmacy profession is very old (as are many pharmacists) and can be traced back to at least 4000BC, where medicinal plants such as liquorice, mustard, myrrh, and opium were used. Records show that these ‘preparers of medicines’ were held in high regard in society and often combined this role with that of priests. Egyptian records dating back to 1500BC show that over 700 drugs were being used to make infusions, ointments, lozenges, suppositories, lotions, enemas, and pills. Similarly, in China (2000BC) records contain descriptions of 365 plantbased drugs. In the UK, the earliest recorded shop dealing with sales of medicines in London was opened in 1345.

Chemist, chemist and druggist, pharmacist or apothecary? Ask people on the street what ‘you’ are called, and many will probably say chemist. Is this right? Write down in the box below what you understand by the terms chemist, pharmacist and apothecary.

It is certainly true that the terms ‘chemist’ and ‘pharmacist’ are used interchangeably by many people. Chemist is often the ‘lay’ public, and I am sure you have used it yourself; ‘I’m just popping in to the chemist’. The term chemist has a long history and historical documents sometimes refer to those involved with the study of the science of pure chemistry rather than pharmacy. Chemist and Druggist was a term widely used in the late 18th and 19th century to describe both chemical and drug merchants and practitioners of the emerging profession of pharmacy. In England, the word 'pharmacist' was first used in 1834 in the novel ‘The Last Days of Pompeii’, although most people working in this area would have called themselves chemists and druggists. Under the 1868 Pharmacy Act, the term chemist and druggist was used by the Pharmaceutical Society of Great Britain (see below) to denote those who had met the minimum requirement to register as a pharmacist. The Apothecaries – Over the 16th and 17th centuries the art of the apothecary was developing rapidly in Britain and in 1617 apothecaries were granted a royal charter, which distinguished them from grocers. Although the apothecary's practice included a strong dispensing element, it also involved examining and treating patients. The 1815 Apothecaries Act enabled apothecaries who took a specified course of training with the Worshipful Society of Apothecaries to be licensed as general practitioners. From 1815 onwards, it was illegal to use the title apothecary without qualification. The outcome of the new Apothecaries Act was a clearer definition of the two streams of practice involving medicine and pharmacy.

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As apothecaries moved into a more advisory role, pharmacists (or chemists and druggists) became the maker and supplier of medicines.

Becoming a pharmacist A modern pharmacist is a highly qualified and knowledgeable healthcare professional. Pharmacists play a key role in delivering quality healthcare to the population. All pharmacists must be registered with the independent professional regulatory body, the General Pharmaceutical Council (GPhC). It is illegal to call yourself a pharmacist unless you are on the register of pharmacists. Click here for details of the process and the requirements you must satisfy. It is extremely important that, as a pharmacy student, you do not present yourself as a pharmacist or pharmacy technician or allow people to assume that you are a pharmacist or pharmacy technician. Before you can register as a pharmacist you need to complete:   

An accredited four year Master of Pharmacy (MPharm) degree (such as the programme you are currently on). A one year pre-registration training course in a pharmacy A registration assessment

Both your degree and your pre-registration training must be approved by the GPhC. What skills and qualities does a pharmacist need? Complete the table below. The national careers service say that to become a pharmacist you will need to have: -

good communication skills

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an interest in the health and wellbeing of people

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a high level of scientific understanding and ability

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a logical approach to problem solving

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good maths skills, with the ability to calculate and use scientific formulae

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accuracy and attention to detail

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the ability to organize and prioritize your work

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a responsible and security-conscious attitude

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the ability to train and supervise others good business skills (for running a community pharmacy)

How does this compare with your list? Think about your own existing skills and characteristics, which ones need development?

The Pharmacy Team

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Pharmacists and pharmacy technicians are required to be registered with the GPhC but that does not constitute the whole pharmacy team. Which other people contribute to a pharmacy service? Note down your answers below.

For each of the roles you identified (e.g. pharmacist, technician), write down what you feel are their core roles and functions. Think about how these people work together to provide a pharmacy service.

Where do Pharmacists work? Pharmacy is a very vocational course, with most graduates going on to practise as a pharmacist. List the sectors of work where you could practice. For each also guess at the proportion, as a percentage, that work in each of the sectors you have listed. Here are some workforce data on the major employment sectors for pharmacists: Community Pharmacy – 65%

Industry – 3%

Hospital Pharmacy – 20%

Academic Pharmacy – 3%

Primary Care including GP surgeries – 10% These figures are approximate and are complicated by those pharmacists who are employed in more than one sector. For example, the University employs several Teacher-Practitioners who work in both academia and in hospital pharmacy. Pharmacy, like the NHS is in a state of change. Over the next few years we expect that there will be fewer community pharmacies (and fewer community pharmacists) whilst the primary care sector is expected to grow markedly. Up to 6000 pharmacists will be employed in Sustainability and Transformation Partnerships (see later under Structure of the NHS). Other areas in which pharmacists are often employed include; medical writing, prison pharmacy, medical law, clinical research, medical sales, toxicology and the civil service (e.g. working for agencies such as the MHRA, Department of Health, NICE).

What does a pharmacist do? A pharmacist is an expert in medicines and their use. The knowledge they have of medicines and their effects is critical in healthcare. A pharmacist’s job can be very different depending on the sector they are working in. Community pharmacy is currently the largest sector of employment. There are approximately 14, 000 pharmacies in the UK. A core function of community pharmacy has been, and continues to be, dispensing prescriptions. Over 1 billion prescription items are dispensed each year! However, community pharmacy is much more than just dispensing prescriptions; indeed dispensing is becoming less important to community pharmacies. In the table below write down what else you think pharmacists do. As a community pharmacist, your work could include:

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-

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Dispensing medicines (although much of the dispensing process is delegated to pharmacy technicians and dispensing assistants or can be automated). Ensuring legal and professional requirements for medicine storage and supply are met. Ensuring that prescribed medicines are safe and appropriate for specific patients. Ensuring that newly prescribed medicines are safe for the patient to use with other medicines. Advising patients how to use their medicines safely and effectively. Reviewing patients’ actual use of medicines and addressing any problems. Advising other healthcare professionals, including doctors and nurses, on how to choose medicines and use them correctly. Advising other healthcare professionals on correct dosages and the most appropriate form of a medicine for a specific patient. Responding to patient symptoms providing advice and information to patients on the most effective treatments for a particular condition including those for sale over the counter without prescription. Providing information about side effects and drug interactions Monitor and review patients to ensure their treatment is safe and effective. Offer health advice to patients. Delivering a range of services to patients including things like weight management, emergency hormonal contraception and smoking cessation. Running clinics.

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Writing and reviewing standard operating procedures.

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Educating and training colleagues.

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Have a look at the information at https://www.rpharms.com/resources/careersinformation/career-options-in-pharmacy/community-pharmacy to find out more. As a hospital pharmacist you might: -

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Supply or oversee the supply of medicines to wards or directly to patients who are being discharged. Conduct medicines reconciliation (Find out what this means). Provide advice and information to other healthcare professionals. Be involved in decisions about prescribing including starting, stopping or changing medicines. (Prescribing on a ward is rarely an individual decision but is usually the result of a discussion among a wider team of healthcare professionals). Provide a medicines information service. Run clinics. Ensure legal and professional requirements for medicine storage and supply are met. Ensure that prescribed medicines are safe and appropriate for specific patients. Ensure that newly prescribed medicines are safe for the patient to use with other medicines. Advising patients how to use their medicines safely and effectively (counselling).

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Review patients’ actual use of medicines and address any problems.

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Conduct audits.

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Put together formularies (find out what this means).

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Manage drug budgets.

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Oversee the production of aseptic and radiopharmaceutical products (find out this one too).

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Provide out of hours advice when on call.

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Write and review standard operating procedures.

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Educate and train colleagues.

Have a look at https://www.rpharms.com/resources/careers-information/career-options-inpharmacy/hospital-pharmacy to find out more.

The Royal Pharmaceutical Society www.rpharms.com The Royal Pharmaceutical Society is a professional body that represents the interests of its members. It is not compulsory to join in order to practice as a pharmacist. However, the RPS offers many benefits including a wide range of online educational resources to members. As a student, membership is free and we strongly encourage you to join. The RPS is a body constituted by Royal Charter its aims are: (1) to safeguard, maintain the honour, and promote the interests of pharmacists in their exercise of the profession of pharmacy; (2) to advance knowledge of, and education in, pharmacy and its application, thereby fostering good science and practice; (3) to promote and protect the health and well-being of the public through the professional leadership and development of the pharmacy profession; and (4) to maintain and develop the science and practice of pharmacy in its contribution to the health and well-being of the public. The overall strategic direction of the Society is provided by an Assembly. Strategy is delivered through national boards representing England, Scotland and Wales. Three boards were created to reflect the differences in healthcare provision created by devolution of powers to the respective countries through UK law. You can find out more about the national boards by clicking on the links below.

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English Pharmacy Board

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Scottish Pharmacy Board

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Welsh Pharmacy Board

The General Pharmaceutical Council The General Pharmaceutical Council (GPhC) is the independent regulator for pharmacists, pharmacy technicians and pharmacy premises in Great Britain. The GPhC’s remit is to protect, promote and maintain the health, safety and wellbeing of members of the public by upholding

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standards and public trust in pharmacy. Power to permit the council to perform this role was laid down in the Pharmacy Order 2010. Their main functions are to: 

approve qualifications for pharmacists and pharmacy technicians and accredit education and training providers (i.e. Schools of Pharmacy);

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maintain a register of pharmacists, pharmacy technicians and pharmacy premises;

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set standards for conduct, ethics, proficiency, education and training, and continuing professional development (CPD);

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establish and promote standards for the safe and effective practice of pharmacy at registered pharmacies;

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establish fitness to practise requirements, monitoring pharmacy professionals' fitness to practise and dealing fairly and proportionately with complaints and concerns.

Pharmacists and pharmacy technicians must be registered with the GPhC. Every registrant has to revalidate their membership annually and pay a fee. This involves an annual declaration of their fitness to practise and submitting 4 continuing professional development records. From 2019 they will also have to submit a reflective written piece and have a discussion about their practise with a professional colleague. Failure to comply with this can lead to people being removed from the register. Members of the public can check to see if any individual is registered to practise. Search the registers for: Samaira Kauser, Dr Jan Daly and Mrs Baljit Mattu. Are these people registered with the GPhC and on which register? You can also check to see if a pharmacy is registered. Try to find Boots the Chemists’ pharmacy in the Mander Centre in Wolve...